October is here!!  It’s crunch time to get everything done that we haven’t gotten done during the rest of the year. For those with remaining dental benefits, it’s also the time of year to consider utilizing those so you don’t lose them.

Unused dental benefits go directly back to the insurance company, which generates hundreds and hundreds of thousands of dollars for the insurance companies each year. Dental insurance companies count on the fact that many people will not claim their $1000 or so in benefits by the end of the calendar year. Those with dental benefits should look for legitimate means to use these benefits before they are lost.

For example, perhaps a crown has been recommended by your dentist, but you have procrastinated about it. It would make sense to consider using those dental benefits before the end of the calendar year. This allows a whole new round of dental benefits to be used for unexpected dental needs the following year, and maximizes the value of the premiums paid.

Remember, insurance companies are in the business to make money. They don’t want you to use your dental benefits. If the balance (co-payment) you will owe for the dental work that needs to be done is too much for you, consider financing options through your dental office. Most dental offices offer interest-free financing to patients for up to 12 months. Financing your balance in this way may make more financial sense than throwing money away to fund the insurance company’s pocketbooks.

Another thing to consider as the end of the year approaches is the use of flex spending accounts. Many employers now offer pre-tax flex spending accounts for healthcare expenses. Often underutilized, these are excellent mechanisms for saving about 20 percent on needed dental care. If you are paying for your dental insurance premiums, it may even make sense to fund an available flex spending account with that premium money instead of, or in conjunction with it.

For instance, if you are anticipating the need for $3000 in dental care, opting to place the $3000 in a flex spending account can save the income tax on those monies and can usually be used as soon as January 1^st. If you have money left in a flex spending account, remember to check with your employer to determine if that money needs to be used by the end of the year. You don’t want to lose that money either.

As you begin to make financial decisions for the end of this year and for the upcoming year, consider a discussion with your dental office’s financial person. They are often an untapped wealth of information and can usually thoroughly and knowledgeably discuss your dental financial options with you.

And, don’t wait too long. Dental office schedules get full quickly this time of year with patients trying to use dental insurance benefits and unused flex account money. Maximize your hard earned dollars.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

No two dental practices are alike! Each takes on the characteristics of the practitioner who owns it.  The personality of the owner is probably the key to how that office “feels” when you walk in the door.  Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  The dentist’s personality is reflected in his or her treatment preferences as well.

In my experience, all dentists will suggest what they feel to be the very best plan for any given patient.  The differences between the treatment suggested by one dentist and that of another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment.  

I presented a complex case situation to a group of 15 dentists this past week. Even among this group of like-minded dentists, there were many different opinions as to how to approach this patient’s care. Some dentists said they would not do anything, while others offered very sophisticated treatment plans.

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances.  A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is helpful if the dentist takes the patient’s ability to pay into account. 

Think of treatment plans like various models of cars at dealerships.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it.  

Dental treatment plans are like that too.  Saving a badly damaged tooth with a root canal and a crown will preserve it for a long time, but it is a larger investment than the alternative extraction.  Replacing a missing tooth may be done with an implant or fixed bridge (which remains in the mouth and is not removable), or a removable partial denture. One is a larger investment than another. The implant, for example, provides a more natural solution, but requires a higher level of care. A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision. 

All dentists who have graduated from an accredited dental school should be technically competent to perform any procedure that they personally feel comfortable with.  But it is important to remember that each one is an individual, and no two dentists can perform exactly the same technical procedure in exactly the same way. 

As a patient, you have no way to be able to judge the quality of the clinical treatment performed. Did it hurt? Does it look and feel good after? Do I feel the investment was worth it? Those are the parameters most patients use to assess success.

Over the years, I have developed a deep respect for those who practice dentistry. Many of my colleagues have impressed me with their technical abilities, and others with their communication skills. There are many great provider options for patients to choose from.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

This week the topic has nothing to do with dentistry. It is a topic that some will be able to relate to and others may not. It is a topic that some may appreciate and others may criticize. It may be something you have thought about before or maybe have never thought about. It is about thinking outside the box and being comfortable with the uncomfortable.

Regardless of your line of work, there comes a point when we all get comfortable with where we are and how we do things. Initially, that is a good feeling, but eventually it is a feeling that challenges us in our own growth. It is impossible to go through life doing things the same way and feel content forever.

In my 25th year in this profession, I do very few things the same as the way I was originally taught. I am constantly learning, but often struggle with how to apply things I learn, or whether to apply them at all.  However, being uncomfortable with being comfortable challenges me to grow.

Many of us, and especially people in a service-related industry, which I can relate to the most, can exhaust ourselves trying to predict and control what other people think about us as individuals and about the work we do. This feeling is a trap and very self-limiting.

Do people understand me? Do they like me? Do they know how much I care about what I do? Do they care? These questions can paralyze us into inaction. These feelings can cause us to never even come close to reaching our full potential. We “play it safe” too often, and need to consider going outside our comfort zone to realize growth, both personally and with our work.

Has this thought ever crossed your mind: “What in the world is my purpose while I’m here on this planet?” We have to have purpose, otherwise we are lost, and we have to have faith or we remain lost.

We all go through the various stages of life and experience joy and happiness, sorrow and pain, confusion and temptation. Some struggle with these things more than others, which can also impede our growth as individuals.  Each of us looks for the things in life that brings us more joy and happiness rather than other things listed above. However, focusing on “what’s in it for me?” can be just as destructive.

Constant growth in mind, body and spirit are essential to mature as individuals. We need to be mature enough to recognize that each of us has our own set of resources, and be able to determine how these resources can help others versus being a roadblock.

We all have our faults, admitted or not. Most of the time we are unable or unwilling to express our faults to anyone because of pride. We want everyone around us to think that we have no “issues”. It takes awareness to allow for self-reflection and at least admitting to ourselves where we need to improve in our personal and professional lives.

This is difficult to do alone. Your best bet is to work together with someone close to you who also has similar intentions so that you can hold each other accountable. Perhaps one of those areas you wish to improve is your own health.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Have you ever thought about how much your tongue actually does? Without it, you wouldn’t be able to taste your favorite foods, whistle your favorite song, or tell someone about your day. That’s why, according to your dentist, it’s important to not only brush and floss your teeth, but to clean your tongue as well. Let’s take a closer look at why and how you should clean your tongue every day.

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What makes for an ideal doctor? Patients shared their views in a study which appeared in an issue of Mayo Clinic Proceedings. It’s based on nearly 200 patients treated at the Mayo Clinic in Arizona and Minnesota.

In phone interviews with people who had no professional ties with the Mayo Clinic, the patients described their best and worst experiences with their Mayo Clinic doctors, with confidentiality guaranteed. The doctors seen by the patients came from 14 medical specialties.

Here are the seven traits listed by the patients, along with the patients’ definitions of those traits:

• Confident: “The doctor’s confidence gives me confidence.”
• Empathetic: “The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.”
• Humane: “The doctor is caring, compassionate, and kind.”
• Personal: “The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.”
• Forthright: “The doctor tells me what I need to know in plain language and in a forthright manner.”
• Respectful: “The doctor takes my input seriously and works with me.”
• Thorough: “The doctor is conscientious and persistent.”

That list isn’t in any particular order. The researchers didn’t check whether confidence was more important to patients than respectful treatment, for instance. The Mayo Foundation funded the study.

The traits covered doctor’s behavior, not technical know-how. That finding “does not suggest that technical skills are less important than personal skills, but it does suggest that the former are more difficult for patients to judge,” the researchers write. They add that patients may tend to assume that doctors are competent unless they see signs of incompetence, the researchers add.

One patient put it this way in the study: “We want doctors who can empathize and understand our needs as a whole person. We want to feel that our doctors have incredible knowledge in their field. But every doctor needs to know how to apply their knowledge with wisdom and relate to us as plain folks who are capable of understanding our disease and treatment.”

The opposite of those seven traits would be: timid, uncaring, misleading, cold, callous, disrespectful, and hurried. Can healthcare ever be high-quality if the patient-doctor interaction is any of these?

I hear so many deeply touching stories from patients who have had such positive experiences with doctors and nurses during tough medical situations. People who are cared for in this way receive much more than physical wellness.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

The Golden Years are much more “golden” if your teeth are in good shape. One of the most difficult areas I have had to address in my time as a dentist are issues concerning aging patients, specifically those who require assisted or nursing care.

Whether you are the one making decisions for someone else, or you are older and can make your own decisions, it is easy to let home care and regular dental visits decrease as time goes on. Dental health needs to stay at the top of the priority list for many reasons. Quality of life and the link between oral health and systemic health are two big ones.

Older patients will often say, “I don’t need to fix that. How much longer do I really have to live?” And every time I respond the same way, “If you told me that you knew you weren’t going to be around next year I’d say I would agree with you…..but you’ve been saying the same thing for 15 years.” It’s worse when the patients lose key teeth when they had the opportunity to keep them for their lifetime.

When an elderly patient has a multitude of dental issues in which some significant decisions need to be made, I consider the following issues:

• What is the general health status?
• How old is the patient?
• What is the general prognosis medically?
• Has the patient ever worn anything removable in their mouth?
• What is the minimal amount of dentistry that can be done that will not alter the patient’s quality of life?
• What are other treatment options to maintain or improve the patient’s quality of life?

The general health status of the patient plays a big role in deciding how to approach a patient’s dental care. People who have medical problems that are well controlled are usually okay to receive general dental care. If a person is in good physical and mental shape, it is hard to use age as a determining factor for not maintaining good dental health.

The most important factor which I believe needs to be considered is about quality of life. Studies have shown that loss of teeth results in a loss in quality of life. Some people with dentures have told me that they can eat anything. Others would pay anything to have their teeth back. The point is the enjoyment of eating. There is no one who could argue that eating with false teeth is as enjoyable as eating with real teeth.

The worst thing you could do to a 70+ year old person (or for that matter anyone, but the older you get the worse it is) is to remove teeth and make them wear something removable in their mouth. Dentures can be very difficult to adjust to, and it is even harder when you are older. The problems with dentures not staying in, the patient not wanting to wear them, and impacting a patient’s nutritional intake are all issues that are much more difficult for the elderly.

The best way to avoid having to deal with major issues as you get older is to make sure you take care of your teeth while you’re younger. If someone you love ends up in a nursing facility, one of the most important things you could do for them is to make sure they get proper dental care.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Gathered from various sources:

50% consider the smile the first facial feature they notice.

80% are not happy with their smile.

Smile enhanced procedures outnumber eyelid surgeries 5 to 1.

32% of Americans cite bad breath as the least attractive trait of their co-workers.

38.5 total days an average American spends brushing teeth over lifetime.

 73% of Americans would rather go grocery shopping than floss.

60% of people don’t know that a sore jaw, when combined with chest pain, can signal a heart attack, especially in women.

Dentists recommend that a toothbrush be kept at least six (6) feet away from a toilet to avoid airborne particles resulting from the flush.

 A toothpick is the object most often choked on by Americans.

Every year, kids in North America spend close to half a billion dollars on chewing gum.

The number of cavities in the average mouth is down and people are keeping their teeth longer. People, on average, have healthier mouths than even 10 years ago. 

The decline in tooth decay was greatest among kids but holds across every age group. 

Only 40% of young people age 6 to 19 have ever had a cavity in their lives.  That’s down from 50% a decade ago.

Over the last ten years the proportion of people age 60 that had lost all their teeth had decreased from 33% to 25%.

Adults with post-high-school degrees had an average of three more teeth than those without a high school diploma.

Smokers remain three times more likely than non-smokers to lose all their teeth.  This figure has not changed from a decade ago.

Socio-economic status plays a definite role in one’s general and dental health.

33% of low-income adults have untreated decay.  This compared with 16% of middle- and higher-income adults.  19% of kids living in poverty have untreated decay compared with 8% of higher-income kids.

More people use blue toothbrushes than red ones.

Like fingerprints, everyone’s tongue print is different 

The average woman smiles about 62 times a day! A man?  Only 8!

Kids laugh around 400 times a day. Grown-ups just 15.

Smilers in school yearbooks are more likely to have successful careers and marriages than their poker-faced peers.

It is common sense that infected teeth, whether they hurt or not, or are broken down beyond repair, should be removed. We also all know by now that there are mouth-body connections and that the mouth is the “gateway” to the rest of the body. There is no disputing that a healthy mouth is better for you on many levels. However, in a recently released study, the guidelines for treatment of some types of dental problems prior to specific surgery need closer consideration.

According to a study in an issue of The Annals of Thoracic Surgery, removing an infected tooth prior to cardiac surgery may increase the risk of major adverse outcomes, including risk of death prior to surgery. This is a very specific study for a very specific group of patients. It does suggest considering postponing dental problems prior to any surgery.

Dental extraction of abscessed or infected teeth is often performed to decrease the risk of infection during surgery and endocarditis (an inflammation of the inner layer of the heart) following surgery. In this particular study, physician researchers evaluated the occurrence of major adverse outcomes in 205 patients who underwent at least one dental extraction prior to planned cardiac surgery. The median time from dental extraction to cardiac surgery was 7 days (average 35 days).

One of the researchers explained, “Guidelines from the American College of Cardiology and American Heart Association label dental extraction as a minor procedure, with the risk of death or non-fatal heart attack estimated to be less than 1%. Our results, however, documented a higher rate of major adverse outcomes, suggesting physicians should evaluate individualized risk of anesthesia and surgery in this patient population.”

In this study, patients who underwent dental extraction prior to cardiac surgery experienced an 8% incidence of major adverse outcomes, including new heart attack, stroke, kidney failure and death. Overall, 3% of patients died after dental extraction and before the planned cardiac surgery could be performed. Another of the researchers went on to say, “With the information from our study we cannot make a definitive recommendation for or against dental extraction prior to cardiac surgery. We recommend an individualized analysis of the expected benefit of dental extraction prior to surgery weighed against the risk of morbidity and mortality as observed in our study.”

This study, as in many “new” studies, awakens us to consider a departure from current lines of thinking about specific situations. This paradigm shift of thinking has also been noted in the use of prophylactic antibiotics prior to dental procedures in those with cardiac conditions.

Prophylactic antibiotics have routinely been prescribed for patients undergoing dental work who also had existing heart problems because it had been accepted that there is a link between dental bacteremia and endocarditis. Individuals with pre-existing heart problems tend to have a higher incidence of endocarditis. The American Heart Association and others have withdrawn support for this practice of prophylactic antibiotics because the danger from overuse of antibiotics outweighs any other potential risks. Regular tooth brushing, flossing, and even chewing gum are now recognized to dislodge as much, if not more, bacteremia than most dental procedures.

Prevention of dental problems is the best line of defense. Regular professional maintenance, especially as we age, is important to our overall health. Talk with your dentist and physician about your specific situations.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

In the last couple of columns I discussed the state of dental insurance in 2019. If you missed them you can read them at www.thetowncommon.com or my blog. The basic gist was that the dental insurance industry has not changed significantly in 40 years.  

It’s great if you get dental insurance from your employer for regular dental hygiene visits and have relatively small amounts of dental work to do. However, there are only a few reasons to purchase dental insurance on your own, even if you need a significant amount of dentistry. In this column, I will discuss the best strategies to get the dental care you need.

One thing is certain; most dental problems do not go away, and almost always get worse over time. Although pain is a good indicator that there is a problem, pain is also not a good indicator that there is not a problem. Many, if not most, dental problems do not cause pain. Cavities, gum disease, wear or erosion of the teeth, often do not cause pain until there is a significant problem, which then requires extensive and expensive treatment to solve. Therefore, the first and most important strategy is regular dental visits.

All too often I see people who have not been seeing a dentist on a regular basis and then have a problem that brings them to the dental office. The most reported reasons for having not been to a dentist are lack of insurance or lack of concern because “everything has felt fine up until now”.

As in most things in life, we have to make choices about what to do with our time and our money. Dentistry is no different. It is a mindset and a budgeting issue. If you value your health and overall self-care, regular maintenance visits to your dentist are the best thing you can do for yourself. If you have any type of dental insurance, at least you have some coverage for this. If you do not have dental insurance, budgeting the average $30 per month it costs over a year to have your teeth cleaned, x-rayed and examined is a smart move, and doable for most.

After you have made the decision to budget for maintenance, regardless of how much other dentistry you need, or think you need, the second key is to be in a dental office that you are comfortable with. It is vital for there to be a mutual level of trust and respect. It is imperative for the dental office to understand you, the patient; where you are in your life, and how to get the most important thing out of your decision to seek care – to keep your teeth healthy for your lifetime.

There is no disputing that dentistry costs money, regardless of whether you have any coverage or not. Dental insurance is not intended to cover 100% of dental needs.  There are so many options out there for people who require more extensive care. However, the key is – what is suitable for you? Patients need to be guided into care and not sold a commodity. There are many reasons that individuals choose a specific provider, but the most important factor is if you feel good about where you are.

When you go to buy a house, does the real estate agent show everyone the same house? No. They show them what fits into their life at that particular time. Dentistry should be approached the same way. It may not be the right time in your life to have the four bedroom house and the three car garage. But, having a good solid roof over your head that is comfortable is important to everyone. This is regular dental maintenance. You can always upgrade.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Last week I explained how dental insurance works in general, and why there is no “good” dental insurance. This week I will break down the general differences between dental insurances, offer some things to consider when using your dental insurance, and when it makes sense to consider purchasing insurance if you don’t have it.

We get asked just about daily by patients who are either self-employed or are not offered insurance through their employer, “Should I consider getting dental insurance?” In most cases, it does not make sense to purchase dental insurance on your own. This goes back to last week’s column as to how dental “insurance” is set up to begin with.

As I discussed last week, all dental insurance companies set a limit as to how much they will “pay-out” on an annual basis. The industry average is $1000 per year, which has not changed since the inception of dental insurance back in the 1970’s. The premiums for individual dental insurance run around the $700 range. This leaves the patient with a net gain of $300 from the insurance company. This especially does not make sense if you typically only have your teeth cleaned a couple of times a year. The only way purchasing your own insurance may make sense is if you are looking to cover your entire family. You should discuss these factors with your dental office prior to making the decision. Key: You should be the one to make the decision who you pick as a dental office, not an insurance company…..that company may change next year.

In dentistry, there are a few types of dental insurance available. There are “open” insurance plans, where patients can go to whoever they want and a certain percentage of the fee will be covered depending on the procedure. The other types of insurance are PPO’s, HMO’s and discount plans or “clubs”. With these types of insurance, the dentist has to sign a contract with the insurance company and abide by a pre-set limit they can charge for all procedures. While this may sound good from a patient perspective, there are other things to consider.

Many private dental offices are being bought-up by larger corporations across the country. In general, the business model of these practices is to see a higher volume of patients. There will be less and less privately-owned dental practices as time goes on. However, in our area right now, most dental offices are small businesses. The decision for the dentist to sign-up for a particular plan depends on many factors.

As a consumer, and patient, you have to be the one to decide what is important to you. Keep in mind that dentistry is not a commodity. Dentistry should be relationship based. Approaching it this way will give you the best opportunity to get the level of care that is right for you.

Please keep in mind: Insurance does not equal health. Health requires investment and personal responsibility. Better access to care across the general population is a topic for another time. Right now, you have full control in managing your dental health care. You should talk to your dental office about any concerns you have.

Next week I will discuss the costs of dental care for those with or without dental insurance and ways to get what you want with regards to your dental health.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.